Project Summary Children from immigrant families constitute one of the largest and fastest growing racial and ethnic minority population groups in the United States. Yet, immigrant children's oral health status, dental needs and dental service utilization are understudied and poorly understood. Few published studies on oral health of immigrant adults and children are based on convenience and small sample sizes or Medicaid data from a single state and all have provided mixed results. The specific characteristics within the foreign-born population that could explain any differential uptake in dental service utilization to address disparity is limited. In addition, existing literature on oral health disparities have focused on socioeconomic factors and do not include social and cultural determinants of oral health such as immigration status. This gap in knowledge specifically hampers the development and implementation of appropriate policies and programs that could achieve positive oral health outcomes for immigrant children. Immigrant oral health is influenced by individual, community and healthcare system factors both before and after immigration, yet it is unclear how these factors contribute to overall oral health disparities. Immigrant children's oral health is a growing dental public health concern due to the significant consequences of common oral diseases if left untreated. The overall goal of this project is to address the gap in knowledge related to immigrant children's oral health and to explore how immigrant children's oral health characteristics contribute to oral health disparities. In addition, this study will identify specific characteristics and health care level factors required for appropriate intervention to reduce these disparities. The specific aims of this study are: (1) to determine the patterns and time trend of dental services utilization and unmet dental needs of foreign-born children from 2002 to 2014; and (2) to examine the extent to which immigrant status factors such as length of stay, language spoken at home and other person-level demographic factors explain variations in dental access, utilization and unmet dental needs of foreign-born children compared to native-born children from 2002 to 2014. This project will be conducted by a team of multidisciplinary researchers using two nationally representative databases: the 2001-2013 National Health Interview Survey (NHIS) and the 2002-2014 Medical Expenditure Panel Survey (MEPS). Descriptive statistics will be conducted to provide estimates of counts and rates of dental services utilization and unmet dental needs. Logistic regression models will then be fit to determine outcome variables associated with other covariates. Structural equation modeling (SEM) will be used to describe the relationship between latent phenomena captured by multiple related variables, such as acculturation. Findings from this project will be used to inform the development of priorities and policies directed at immigrant children's oral health and oral health disparities.